Ozempic and Breastfeeding: Safety, Risks, and Alternatives
Semaglutide is not recommended during breastfeeding due to limited safety data, though accidental exposure is unlikely to cause serious harm. Understanding FDA guidance, potential risks to nursing infants, safer weight loss alternatives, and the timing for resuming semaglutide after breastfeeding helps mothers make informed decisions balancing their health needs with infant safety.
Pregnancy, Breastfeeding, and GLP-1 Medications: Overview
Semaglutide and other GLP-1 receptor agonists are not approved for use during pregnancy or breastfeeding. This is not because proven harm exists—rather, it reflects the absence of adequate safety data in these vulnerable populations. The FDA and other regulatory agencies apply conservative standards to medications during pregnancy and lactation, requiring robust evidence of safety before approving use. In the absence of such evidence, recommendations typically advise against use, prioritizing caution over uncertainty.
The postpartum period represents a critical window where mothers often experience urgent weight loss desires, particularly after substantial pregnancy weight gain. Many women gain 25-35 pounds during pregnancy, with some gaining considerably more. After delivery, mothers are often highly motivated to lose this excess weight, leading many to consider medications like semaglutide. However, the overlap between postpartum recovery, establishing breastfeeding (in those choosing to nurse), and medication safety creates complex clinical decisions requiring careful consideration.
Understanding FDA guidance, available safety data, potential risks, and safer alternatives helps mothers and healthcare providers navigate these decisions thoughtfully. For many, delaying semaglutide until after breastfeeding ends—while pursuing safer weight loss approaches during this period—represents the most prudent strategy. However, individual circumstances vary, and discussions with obstetricians, pediatricians, and pharmacists should guide personal decision-making.
FDA Guidance on Semaglutide During Breastfeeding
The FDA explicitly recommends against semaglutide use during breastfeeding. This recommendation appears in semaglutide product labeling (Ozempic, Wegovy, Rybelsus prescribing information) under the section addressing use in nursing mothers. The rationale provided is: insufficient data exist regarding semaglutide concentration in human breast milk and potential effects on breastfed infants.
The FDA's recommendation reflects the precautionary principle—when adequate safety data are absent, caution is warranted. This standard makes sense in medical ethics: infants cannot consent to experimental medication exposure, and pediatric populations are particularly vulnerable to adverse effects. Therefore, regulators appropriately require robust evidence of safety before endorsing maternal medication use that exposes nursing infants.
Importantly, the FDA recommendation against use is not based on proven harm. No documented cases of serious infant adverse effects from maternal semaglutide use during breastfeeding exist in published medical literature. Rather, the recommendation reflects absence of evidence rather than evidence of absence—the data simply do not exist to confidently declare semaglutide safe.
Healthcare providers follow FDA guidance by advising mothers against semaglutide during breastfeeding and recommending waiting until after weaning to resume the medication. However, discussions between mothers, obstetricians, and pediatricians should address individual situations, particularly if the mother has compelling health needs (like uncontrolled diabetes) that might warrant more nuanced risk-benefit analysis.
Semaglutide Pharmacology and Breast Milk Penetration
Understanding how semaglutide is metabolized and transported helps clarify why breast milk penetration would be expected to be minimal, supporting (but not confirming) the safety argument for breastfeeding.
Semaglutide is a 31-amino-acid peptide—a large protein-like molecule composed of a chain of amino acids linked together. One key pharmacological principle is that the blood-brain barrier and other biological barriers (including the lacteal barriers of the breast) discriminate against large molecules. Small, lipid-soluble molecules readily penetrate barriers, while large, polar molecules (like peptides) have difficulty crossing.
Semaglutide's large molecular weight (approximately 4,000 Daltons) and hydrophilic (water-loving) nature predict poor breast milk penetration based on pharmacological principles. Additionally, semaglutide is rapidly degraded by peptidases—enzymes throughout the body that break down peptides. Breast tissue and milk would expose semaglutide to these degradative enzymes, further reducing any intact semaglutide reaching infant exposure.
Animal studies examining semaglutide passage into breast milk show minimal concentrations relative to maternal blood levels. In lactating rats receiving semaglutide, breast milk semaglutide concentrations were approximately 2-3% of maternal blood levels—extremely low exposure. Based on these theoretical and animal data, human breast milk penetration would be expected to be minimal.
However, human data remain sparse. No controlled studies have measured semaglutide concentrations in human breast milk from mothers treated with semaglutide. The absence of such studies creates uncertainty, leading regulators to recommend caution. If adequate human studies had been conducted showing minimal breast milk semaglutide concentrations and no adverse infant effects, FDA recommendations might differ. The absence of such data, combined with the precautionary principle, explains the conservative guidance.
Potential Mechanisms of Infant Harm: Theoretical Considerations
While documented infant harm from maternal semaglutide during breastfeeding has not been reported, plausible concerning mechanisms exist that justify caution. Understanding these theoretical risks clarifies the rationale for conservative recommendations.
First, semaglutide is well-known to cause gastrointestinal disturbance in adults: nausea, vomiting, diarrhea, constipation, and abdominal discomfort occur in 20-40% of users, particularly during dose escalation. If semaglutide transmitted through breast milk, similar GI effects could theoretically occur in nursing infants. While infants have some GI tolerance to various substances through breast milk, unexpected nausea or vomiting could disrupt feeding patterns and comfort.
Second, semaglutide alters gastric emptying—the rate at which stomach contents move into the small intestine. This delayed gastric emptying is part of semaglutide's appetite-suppression mechanism. In infants, altered GI motility could affect normal feeding dynamics, potentially disrupting the coordinated suckling and swallowing that characterize normal breastfeeding and formula feeding.
Third, semaglutide suppresses appetite and reduces food intake desire in adults. If transmitted to infants, this appetite suppression could reduce feeding interest, potentially compromising infant nutrition and growth. Infants require rapid, consistent growth, and anything reducing feeding drive could theoretically affect developmental outcomes.
Fourth, semaglutide affects glucose metabolism, improving insulin sensitivity and lowering blood glucose. In infants with normally stable glucose regulation through frequent feeding, GLP-1 effects on glucose metabolism are unlikely to cause problems. However, in certain circumstances (such as infants of diabetic mothers predisposed to hypoglycemia), GLP-1 effects on glucose could theoretically be concerning.
Fifth, rare but serious GLP-1 side effects include acute pancreatitis (inflammation of the pancreas). While extremely rare in established-use populations, the theoretical possibility of this serious adverse effect in vulnerable infants justifies caution.
It is important to emphasize that these are theoretical risks based on pharmacology and semaglutide's known properties. Actual documented cases of infant harm from maternal semaglutide during breastfeeding are not reported in medical literature. Nevertheless, the theoretical possibility of harm combined with absence of safety data supports conservative recommendations against use.
Postpartum Weight Loss Timeline and Natural Weight Reduction
Understanding normal postpartum weight loss patterns helps contextualize why immediate semaglutide use may not be necessary and why patience and lifestyle approaches often achieve substantial weight reduction during breastfeeding.
Pregnancy weight gain typically involves: increased blood volume and fluid (~3-4 pounds), placental and other tissue growth (~1-2 pounds), and fat stores (~6-8 pounds) in a typical 25-pound weight gain. Immediately postpartum, mothers lose approximately 10-13 pounds with expulsion of the infant, placenta, amniotic fluid, and blood loss—roughly half the pregnancy weight gain instantaneously.
Over the following weeks to months, additional weight loss typically occurs through: water/fluid loss (diuresis), continued fat loss from dietary intake below caloric needs, and caloric expenditure from breastfeeding. Breastfeeding requires approximately 500 calories daily—a substantial energy expenditure. Combined with normal postpartum metabolism and lifestyle factors, many breastfeeding mothers lose 1-2 pounds per month without deliberate dieting.
By six months postpartum, many mothers who breastfeed and maintain reasonable eating patterns lose 60-70% of their pregnancy weight naturally. By twelve months, many return close to pre-pregnancy weight without medications. This natural postpartum weight loss trajectory suggests that medication acceleration may not be necessary in the immediate postpartum and breastfeeding period.
Understanding this timeline helps manage expectations. Rather than viewing breastfeeding months as a frustrating period of inability to lose weight, recognizing the natural weight loss occurring during this time reframes it as a period of gradual, sustainable weight loss through physiological processes. This perspective reduces motivation to use medications like semaglutide and supports patience with the natural postpartum recovery process.
Safer Weight Loss Strategies During Breastfeeding
For mothers motivated to actively support weight loss during breastfeeding (rather than relying on natural processes), multiple evidence-based strategies are safer than semaglutide.
Dietary modification is foundational. The key principle is achieving caloric deficit for weight loss while maintaining adequate nutrition to support milk production and maternal health. Recommended approach: include adequate protein (approximately 25-30% of calories) to support satiety, milk production, and muscle preservation; include whole grains providing sustained satiety; include abundant vegetables providing nutrients and fiber; include healthy fats supporting nutrient absorption and satiety; and achieve modest caloric deficit (approximately 300-500 calories below maintenance) supporting gradual weight loss without dramatically reducing milk supply.
Specifically avoid crash dieting or very-low-calorie diets (under 1,500 calories daily), which can reduce milk supply and create nutritional deficiencies. The goal is sustainable, gradual weight loss (1-2 pounds weekly) compatible with breastfeeding continuation.
Physical activity is another evidence-based strategy. Postpartum exercise is safe during breastfeeding and does not reduce milk supply or quality—mothers should wait 6-8 weeks postpartum (after postpartum bleeding ceases and abdominal healing progresses) before initiating vigorous exercise. Thereafter, combination of walking (starting with 20-30 minutes most days), postpartum exercise classes designed for nursing mothers, and gradual progression to resistance training support weight loss without medication risks. Exercise provides additional mental health benefits, fatigue reduction, and cardiovascular benefits beyond weight loss.
Behavioral strategies are important: self-monitoring of eating patterns through food journaling, identifying emotional eating triggers, managing stress through exercise or mindfulness, adequate sleep (challenging with infants but important for metabolic health), and realistic goal-setting support weight loss success. Working with registered dietitians provides personalized guidance and behavioral support.
For mothers with type 2 diabetes or prediabetes requiring pharmacological treatment, metformin is an excellent alternative to semaglutide. Metformin is safe during breastfeeding, passes minimally into breast milk, is not significantly absorbed by nursing infants, and provides both glycemic control and modest weight loss benefits without semaglutide's GI side effects or unknown breastfeeding safety profile.
Metformin as a Safer Diabetic Alternative During Breastfeeding
For mothers with type 2 diabetes or gestational diabetes requiring medication during breastfeeding, metformin represents the preferred pharmacological option over GLP-1 agonists.
Metformin passes minimally into breast milk. Studies examining metformin in breastfeeding women show that milk metformin concentrations are extremely low relative to maternal blood levels—approximately 1% of maternal blood concentration. This minimal breast milk penetration results from metformin's pharmacological properties: it is a small polar molecule that does not cross biological barriers effectively, and it is not metabolized or accumulated in breast tissue. Metformin is not significantly absorbed through the infant GI tract; studies of infants exposed to metformin through breastfeeding show no detectable metformin in infant blood and no adverse effects.
The American Academy of Pediatrics specifically lists metformin as compatible with breastfeeding, assigning it the highest safety category. Additionally, the Lactation Risk Category (formerly Pregnancy Category B, now called pregnancy/lactation exposure registry) considers metformin safe during breastfeeding.
Beyond safety, metformin provides clinical benefits during breastfeeding: improved glycemic control in those with diabetes, modest weight loss (typically 2-3% body weight on average), and no adverse effects on milk supply or infant development. Many diabetic mothers use metformin as their primary diabetes medication during breastfeeding, with excellent outcomes.
After breastfeeding ends, mothers can transition to semaglutide or other GLP-1 agonists for enhanced weight loss and glycemic control if desired. This phased approach—metformin during breastfeeding, transition to semaglutide after weaning—represents an optimal pathway balancing infant safety with maternal health needs.
Timing for Resuming Semaglutide After Breastfeeding Cessation
Once breastfeeding ends, most authorities recommend waiting a brief washout period before resuming semaglutide to ensure any residual semaglutide (in maternal tissue or potential breast milk) has been completely cleared.
Semaglutide has a half-life of approximately 7 days—meaning 50% of a dose is eliminated in 7 days, 75% in 14 days, 87.5% in 21 days, and 93.75% in 28 days. A conservative approach recommends waiting 2-4 weeks after complete breastfeeding cessation before resuming semaglutide. This ensures even small residual semaglutide has been substantially cleared, eliminating any theoretical infant exposure through milk.
In practice, most mothers complete breastfeeding around 6-12 months postpartum, at which point natural postpartum weight loss has substantially progressed. By this time, mothers may have lost 20-30 pounds naturally, with remaining weight loss goals often modest. When transitioning to semaglutide post-weaning, starting at the standard lowest dose (0.25 mg weekly) and titrating upward every 4 weeks is appropriate.
Some mothers opt to continue breastfeeding for 2-3 years (extended breastfeeding), delaying semaglutide even longer. Others wean at 6 months and resume semaglutide for accelerated weight loss in the following months. Both approaches are reasonable; the decision should involve maternal preferences, health needs, and discussion with healthcare providers regarding optimal timing.
Maternal Health Considerations: Balancing Infant Safety with Maternal Needs
While conservative recommendations advise against semaglutide during breastfeeding, some maternal circumstances may warrant more nuanced risk-benefit analysis with healthcare providers. For example, a mother with uncontrolled type 2 diabetes experiencing significant complications might have compelling reasons to use semaglutide despite breastfeeding, particularly if alternative treatments prove insufficient.
Such discussions should involve obstetric, pediatric, and endocrinologic expertise. Providers should consider: the severity of the maternal health condition; the adequacy of alternative treatments (like metformin); the stage of breastfeeding (weaning might be imminent, making brief semaglutide use during final weeks acceptable); the mother's psychosocial well-being (postpartum depression or severe body image distress might warrant intervention); and the family's specific circumstances and values.
Modern medical ethics increasingly recognizes that maternal health matters and that maternal suffering from untreated conditions is also relevant to infant welfare (as maternal health affects infant care and development). While infant safety remains paramount, thoughtful consideration of maternal circumstances may lead providers and mothers to accept calculated risks in certain situations.
However, such decisions should be made explicitly, with full understanding of risks and benefits, in consultation with multiple specialists, rather than through default assumption that all medication use is harmful or acceptable. The goal should be informed decision-making balanced between infant safety and maternal health needs.
Postpartum Depression, Body Image, and Mental Health Perspectives
Pregnancy and postpartum weight gain sometimes trigger or exacerbate body image distress, depression, and anxiety. For some mothers, rapid weight loss through medications like semaglutide feels crucial for mental health recovery. Understanding these psychological dimensions is important for compassionate, comprehensive care.
Postpartum depression affects approximately 10-15% of new mothers and involves depressive symptoms including sadness, hopelessness, anxiety, sleep disturbance, and loss of interest in activities. Body image dissatisfaction and difficulty adjusting to postpartum appearance sometimes contribute to postpartum depression. Some mothers describe intense distress with postpartum body changes and express desperate desire for rapid weight loss and body restoration.
While semaglutide is not recommended during breastfeeding, recognizing postpartum body image concerns validates mothers' experiences and supports consideration of mental health intervention. Postpartum depression screening, cognitive-behavioral therapy, and psychiatric treatment when indicated are evidence-based interventions supporting mental health during breastfeeding. Additionally, cognitive reframing—recognizing body changes as temporary, celebrating postpartum accomplishments, and cultivating self-compassion—supports psychological adjustment.
For mothers experiencing significant body image distress or postpartum depression, comprehensive mental health support, combined with realistic expectations about postpartum weight loss timeline and evidence-based non-pharmacological weight loss approaches, often effectively addresses underlying psychological distress while maintaining breastfeeding and avoiding semaglutide risks.
Accidental Exposure: What to Do If It Occurs
Some mothers taking semaglutide may discover they are breastfeeding, or may take semaglutide accidentally during breastfeeding before learning of a new pregnancy (though unlikely, as breastfeeding provides some contraceptive effect). Understanding responses to accidental exposure reduces unnecessary panic.
For a single accidental semaglutide dose during breastfeeding: The risk of serious harm is low. Given minimal expected breast milk penetration, minimal infant GI absorption, and absence of documented serious adverse events in published literature, a single dose is unlikely to cause clinically significant harm. Appropriate response includes: notifying pediatrician for guidance; observing infant for signs of GI disturbance (unusual fussiness, vomiting, diarrhea) over the following 24-48 hours; and reassurance that serious harm is unlikely. Most pediatricians would recommend observation rather than intervention for accidental single-dose exposure.
For ongoing semaglutide during breastfeeding: If a mother has been taking semaglutide regularly during breastfeeding without realizing breastfeeding is contraindicated, a discussion with obstetrician and pediatrician is warranted. Options include: continuing semaglutide with close pediatric monitoring (if providers and mother agree benefits outweigh risks); discontinuing semaglutide and substituting safer alternatives; or weaning from breast and transitioning to formula, then continuing semaglutide if desired. The decision should be collaborative, with shared decision-making between mother, obstetrician, and pediatrician.
Conclusion: Balancing Safety, Health Needs, and Individual Circumstances
Semaglutide is not FDA-recommended during breastfeeding due to limited safety data, though documented serious infant harm is not reported. Conservative recommendations advise waiting until after breastfeeding ends before resuming semaglutide, pursuing safer weight loss alternatives (dietary modification, exercise, behavioral strategies, metformin for diabetics) during the breastfeeding period.
This conservative approach is justified by the precautionary principle and by the reality that many mothers lose substantial weight naturally during breastfeeding without medications. For most mothers, delaying semaglutide until after weaning (typically 6-12 months postpartum) represents prudent risk management while still allowing semaglutide use once breastfeeding ends.
However, individual circumstances vary, and healthcare provider consultations should address personal situations. Mothers with compelling health needs, mothers considering brief semaglutide use during final breastfeeding weeks, and those with significant mental health concerns may warrant more nuanced discussions balancing infant safety with maternal health. The goal should be informed decision-making that respects both infant safety and maternal well-being.
Frequently Asked Questions
The FDA recommends against using semaglutide during breastfeeding due to insufficient safety data rather than proven harm. Semaglutide is not FDA-approved for use during pregnancy or breastfeeding. The primary FDA concern is the lack of rigorous human studies examining semaglutide passage into breast milk and infant exposure safety. Additionally, semaglutide significantly alters gastrointestinal motility (stomach emptying speed) and nutrient absorption, effects that theoretically could impact breastfeeding or infant GI function if transmitted through milk, though this remains speculative. The conservative FDA recommendation reflects the precautionary principle—in the absence of proven safety data, avoiding use during breastfeeding is prudent. However, if accidental exposure occurs during breastfeeding, a single dose is unlikely to cause serious harm given the small amounts expected in breast milk. Mothers considering semaglutide should discuss risks and benefits with their obstetrician, pediatrician, and pharmacist, who can weigh individual circumstances.
Limited data exists on semaglutide concentration in human breast milk. Semaglutide is a 31-amino-acid peptide, a large molecule that would theoretically have difficulty passing into breast milk. Breast milk barriers generally exclude large protein molecules effectively. Animal studies suggest minimal semaglutide passage into breast milk relative to maternal blood levels, but human data remains sparse. No controlled studies have measured semaglutide concentrations in human breast milk from treated mothers. The limited available data comes from case reports and observational accounts rather than systematic measurement. Given that semaglutide is a peptide (not a small, lipid-soluble molecule), and given theoretical barriers to peptide passage into milk, the absolute amount likely reaching the infant would be minimal. However, the absence of data creates uncertainty. Healthcare providers often err toward caution, recommending against use rather than allowing use with unknown risks.
Potential risks to infants from semaglutide exposure through breast milk remain largely theoretical, as confirmed adverse events are rare. However, plausible concerning mechanisms exist: First, semaglutide causes nausea, vomiting, and GI disturbance in adults; if transmitted to infants, similar effects could impact feeding tolerance and growth. Second, semaglutide alters gastric emptying (the rate food moves from stomach to intestine); altered infant GI motility could affect feeding dynamics and nutrient absorption. Third, semaglutide suppresses appetite and food intake; in infants receiving breast milk (which semaglutide could theoretically affect), reduced feeding interest could impair growth. Fourth, severe GI adverse effects like acute pancreatitis, though rare, could be concerning if transmitted to vulnerable infants. Fifth, semaglutide effects on glucose metabolism could theoretically affect infant blood glucose, though breast-fed infants typically maintain stable glucose through frequent feeding. These risks remain theoretical; actual documented cases of infant harm from semaglutide via breastfeeding are not reported. However, the potential for harm justifies caution and avoidance during breastfeeding.
Most authorities recommend resuming semaglutide only after breastfeeding is completed. This means waiting until weaning, typically around 6-12 months postpartum when many mothers transition to formula or solid foods. However, guidelines vary: some sources suggest the washout period could be shorter (2-4 weeks after the last semaglutide dose) if the mother is committed to pump-and-dump strategy (expressing breast milk and discarding rather than feeding to baby), though this creates inconvenience. Others recommend waiting until complete weaning to eliminate any uncertainty. The optimal timing depends on individual circumstances: a mother's weight loss goals, health needs, feasibility of delaying treatment, and infant feeding preferences. Consultation with obstetrician and pediatrician is essential. Many recommend breastfeeding for 6-12 months if possible, then resuming semaglutide after weaning. However, if the mother's health condition (e.g., uncontrolled diabetes) requires treatment, benefits may outweigh risks, warranting careful discussion with healthcare providers.
Multiple weight loss approaches are safer than semaglutide during breastfeeding: First, dietary modification focusing on balanced nutrition (adequate protein, whole grains, vegetables, healthy fats) combined with reduced calorie intake supports weight loss while maintaining milk supply. Crash dieting or severe calorie restriction may reduce milk supply and should be avoided. Second, gradual lifestyle modifications (increasing physical activity, walking, postpartum exercise programs) support weight loss without medication risks. Exercise is safe during breastfeeding and provides additional mental health benefits. Third, metformin is safe during breastfeeding for those with diabetes; very small amounts appear in breast milk and are not absorbed through infant GI tract. Fourth, dietary counseling from a registered dietitian can help establish sustainable eating patterns supporting weight loss and milk supply. Fifth, wait-and-see approach—many mothers naturally lose weight gradually over 6-12 months postpartum through breastfeeding (which burns 500-1,000 calories daily) combined with lifestyle modifications, without medications. Breastfeeding itself supports postpartum weight loss through caloric expenditure.
Breastfeeding provides significant caloric expenditure supporting postpartum weight loss: producing breast milk requires approximately 500 calories daily, and combined with other postpartum metabolic changes, breastfeeding mothers often lose weight naturally without deliberate dieting. This caloric expenditure from milk production represents a substantial portion of daily energy expenditure, making breastfeeding a powerful weight loss tool. Combined with healthy eating patterns and moderate activity, breastfeeding mothers typically lose 1-2 pounds per month without restrictive dieting. This natural weight loss through breastfeeding provides a safer alternative to medications like semaglutide during this period. Additionally, the postpartum period is characterized by elevated metabolic rate and hormonal changes favoring weight loss even without medications. Patience and realistic expectations (allowing 6-12 months for gradual postpartum weight loss) often result in substantial weight reduction without medication risks. Once breastfeeding ends, semaglutide or other weight loss medications can be initiated if additional weight loss is desired.
Yes, metformin is considered safe during breastfeeding and represents an excellent alternative for diabetic mothers needing glycemic control. Metformin passes minimally into breast milk—studies show only tiny amounts in milk relative to maternal blood levels, and metformin is not significantly absorbed through the infant GI tract, making exposure negligible. The American Academy of Pediatrics specifically approves metformin during breastfeeding as a safe option. Additionally, metformin promotes modest weight loss (2-3% body weight on average) in those with diabetes or prediabetes, providing dual benefits of glycemic control and weight reduction without the risks of semaglutide. For diabetic mothers requiring pharmacological treatment during breastfeeding, metformin represents the preferred choice over GLP-1 agonists. After breastfeeding ends, mothers can transition to semaglutide or other GLP-1 medications for enhanced weight loss and glycemic control if desired.
Accidental single-dose exposure to semaglutide during breastfeeding is unlikely to cause serious harm. Given that semaglutide is a large peptide with minimal expected breast milk passage, and given that breastfeeding infants ingest breast milk only a few times daily (compared to constant exposure for in-utero fetuses), the absolute infant exposure would be minimal. Additionally, any semaglutide entering the infant GI tract would face degradation by digestive enzymes and minimal absorption through the intestinal mucosa. Case reports of accidental semaglutide exposure during breastfeeding are uncommon, and documented serious infant adverse effects are not reported. However, accidental exposure warrants notification to pediatrician, who can monitor infant for signs of GI disturbance or other concerns. For single accidental doses, reassurance and observation are typically appropriate rather than immediate intervention. Ongoing semaglutide during breastfeeding, however, warrants careful risk-benefit analysis with healthcare providers rather than continuation without monitoring.